Notes towards outlines of materia medica and therapeutics : systematic and practical

NOTES

TOVVARDS

OUTLINES

OF

Its:

SYSTEMATIC AND PRACTICAL.

BY

ALEXANDER HARVEY, A.M. M.U.

L.CTOaER, SOMETrME ON THE mST.TnTES. ANO AKTEUWAUDS ON THE PHACT.CE
OF MEDICINE, IN THE UNIVERSITY OF ABERDEEN.

1857.

PREFATORY NOTICE.

It is a common observation among Medical Students,
that the Materia Medica is the driest and the most
difficult to get up of any of the branches comprised in
their curriculum of professional study. To a certain
extent this is inherent in the nature of the subject.
But it has long appeared to the Writer of these Notes,
that, by combining the Materia Medica more largely
than has of late years been customary in our medical
schools, with the facts and principles of Therapeutics,
and with those of Physiology, Pathology, and Practice of
Medicine, — that is, by connecting, at every step, its own
proper details with their scientific relations and their
practical applications, much may be done towards render-
ing it one of the most interesting. Embracing indeed,
as it does, an endless number and an infinite variety of
minute and perplexing details, it is only, he beheves,
on some such plan that the Materia Medica can be so
taught as at once to engage the interest of the student,
and effectually secure his recollection of those details.

It was in this belief, and with a vievv to the publica-
tion of a short elementary treatise on this plan, that the
following Notes were long ago prepared. And they are

A 2

iv

submitted in their present form — imperfect as they are,
and fragmentary — in attestation of that intention, and to
indicate the manner in which, if a teacher of the Materia
Medica, the writer would consider it his duty to impart
instruction in it to his pupils.

The Writer may perhaps be permitted to add, that
it was on an essentially similar plan that, in the last
century, the celebrated Dr. Cullen taught this depart-
ment of medical science in the University of Edinburgh;
and that his " Treatise of the Materia Medica," although
now (by reason of the advances which have since then
been made in Chemistry, and in Physiology, and Patho-
logy) very defective, and of little value in its theoretical
parts, may still be referred to as in its general plan_, and
in its thoroughly practical character, a model to be
adopted by any teacher of this branch.

CONTENTS.

PART 1.

PAGE

iNTfiODUCTORY 7

PART II.

Materia Medic a and Therapeutics, systematically considered . 23

PART III.

Materia Medica and Therapeutics, practically considered 29

I

NOTES, Ac.

PART I.

INTRODUCTORY.
CHAPTER I.

Preliminary Observations — Objects of Medicine as an Art — Association
of Nature with this Art in the Prevention and Cure of Diseases —
What requisite in order to a clear Perception of the Objects, and
to a just Estimate of the Results of Medical Practice.

The object for which medicine is followed as a profession or
calling, is, the prevention, the cure, the alleviation of human
suffering and disease. But in the accomplishing of this. object, not
Art alone, but Nature also, is concerned — nay, nor yet Art chiefly,
but Nature chiefly; Art being, in point of fact, subordinate to
Nature, auxiliary to her — her handmaid and helper. It is
essential, therefore, to all truly scientific, and to all really satis-
factory practice, clearly to understand what is Nature's share in
this work ; what she can do, and actually does in it ; what she
is incapable of doing, and fails to do. And this requires a
knowledge of the general nature of diseases and of the con-
ditions under which they occur ; of the natural course or pro-
gress of diseases, and of the issues to which they lead. It requires
especially a knowledge of the natural tendencies of diseases,
whether favourable or unfavourable, and of the modes of dying

8

and healing, as occurring spontaneously ; and likewise of the
normal powers and conditions of vitality, as illustrative as well
of the nature of diseases and the mode of action of their ex-
citing causes as of the manner of their spontaneous cure, or
their spontaneous termination in death, — or in permanent and
irremediable lesion of some part or organ.

Such knowledge is essential, because indispensable to a
right judgment of the objects, and to a correct estimate of the
results of actual treatment. For the real objects of all truly
scientific practice must ever be, on the one hand, to aid or pro-
mote the favourable tendencies of diseases and the provisions of
nature for their spontaneous cure, and, on the other hand, to
obviate those that are unfavourable, — and above all, the ten-
dency to death itself. And in the event of recovery, it is always
satisfactory and often very important to determine, as far as can
be done, how much has been due to Nature and how much to
Art — whether Nature was duly aided by Art, or positively
thwarted by her. Nor, in the event of a fatal issue, is it of
less consequence or less interest to determine whether the
result was really inevitable ; whether the tendency thereto was
adequately met j or may not even have been promoted or created
by the treatment employed.

We are exceedingly apt to deceive ourselves in our judg-
ment of the results of medical practice, and are in fact con-
tinually deceiving ourselves — taking credit where none is due,
and even where blame is merited, or wrongfully ascribing to
Nature the obstinacy or the fatal event of diseases. For not all
the cases we speak of as cures were cured by us. Many of
them would doubtless have recovered, as well and as soon with-
out, as with our aid. Not a few of them, pcradventure, have
got well in spite of wrong treatment, and would have done so
all the sooner had they been left to Nature. And it is to be
feared that not all the deaths that happen in medical practice,
nor all the abiding and often painfully distressing effects of
diseases, are exclusively referable to Nature.

So important, therefore, to right conduct in practice, and to
a just appreciation of its real value, is a clear understanding of

9

the whole natural history of diseases, and of the laws and con-
ditions of vitality in its healthy state ; and so directly does our
knowledge of these subjects connect itself with all questions as
to the action, and the application, and the effects of x'emedies,
that, although strictly belonging to physiology and pathology,
a brief exposition of them may yet be regarded as forming a
fitting and even a necessary introduction to the study of the
Materia Medica, and of Therapeutics. And accordingly, in
treating of this department of medical science, we premise some
account of the leading facts which belong to the subjects of life,
health, and disease — referring to these facts, however, and
using, and applying, and reasoning from them with that
view, as truths that are already known, and do not themselves
require any formal or detailed consideration.

CHAPTER II.

Of the leading Facts in regard to the Subjects of Life, Health, and Dis-
ease, which more immediately connect themselves with those of
Materia Medica and Therapeutics.

§1.

Of Life or Vitality, as the exercise of certain powers inherent
in the living body, acting under certain conditions in order to
the attainmeut of certain ends, and giving rise to certain pheno-
mena; — or of life considered in relation to its objects, its mani-
festations, its conditions, and its powers.

Using the word process, as at once including the notion of
vital power (or the capacity of vital action), of the conditions
requisite for the exercise of this power (called often vital stimuli),
and of thfti, resulting action, it may be observed that the most
general and fundamental of the vital processes, continually in
operation in the living body, are the chemical and the plastic, or
those by which the several organic compounds are formed, and
contemporaneously transformed into the various organised struc-
tures of which the body consists, and by which, also, in the tour-
billon vital of the body, these compounds and structures are sub-
sequently disintegrated and resolved into inorganic matter and
cast off. It is these processes of constructive and retrogressive
assimilation, which involve alike the blood and the tissues, the
agency of oxygen, the supply of suitable materials from without,
and a certain temperature, that are concerned in all that is
essential in the vital actions of circulation, of nutrition and
secretion, of absorption and excretion, of respiration and animal
heat. And it is in abnormal aberrations or deflections of these
processes that the far greater number of diseases consist, whether

11

arising from causes acting primarily on the vital powers them-
selves, or from causes more immediately affecting the conditions
essential to the exercise of these powers, or otherwise controlling
or influencing them. Local congestions, or determinations of
blood, hcemorrhages, serous or dropsical eflPusions and fluxes,
inflammation and its products, retained or excessive, or per-
verted secretions, abnormal nutrition and heterologous deposits
(hypertophy, atrophy, transformation of tissue, tubercle, cancer,
hydatids, &c.), all come under this head.

Less general, and more immediately subservient to the main
objects of animal life, but concerned also in the processes already
mentioned, either as directly participating in them, or as capable
of influencing them, are the vital powers of contractility inherent
in the muscular system, and of nervous agency (or innervation)
inherent in the nervous system; and both which, when acting
under their appropriate conditions (or stimuli), give rise to the
involuntary and the voluntary, the reflex and the instinctive
movements, and to the mental operations of sensation and
thought, of emotion and volition. From abnormal afi'ections of
these two powers many important diseases proceed.

Of the conditions of vitality, considered in themselves, those
that more directly bear on the purpose here in view are those
relating to the supply of nutriment from without — to air, and
light, and temperature. And of the vital actions, those on which
the maintenance of vitality is more immediately dependent, and
by the aff'ection or instrumentality of which the spontaneous
cure or the fatal event of diseases is more immediately brought
about, and which, therefore, peculiarly demand attention here,
are those of circulation, nutrition and secretion, absorption,
excretion, and respiration.

§2.

Of Health and Disease as relative states of the living body,
relative modes of action of its vital powers, relative manifesta-
tions of its vital actions. In both, it is the same vital powers
that are in operation, the same vital actions that are exerted, the

12

same vital phenomena that appear — normally in the one, abnor-
mally in the other; the normal and the abnormal, however,
passing so gradually the one into the other, as to nullify all
attempts, rigorously or logically, to define either.

The living body is so constituted as to tend always to act
agreeably to the manner intended by nature; and when so
acting the state of health obtains. It is so constituted, how-
ever, as to be liable to act otherwise ; and when thus acting, to
such an extent or in such a way " as to cause suffering or incon-
venience, or to endanger life," disease obtains.* Conversely,
the circumstances in which the body is placed are, for the most
part, in haraiony with its constitution, and with the appointed
modes and ends of its action. Nevertheless, they are such that
they may, as they often do, act injuriously on it ; and, in fact,
the most general of the external or exciting causes of our
diseases are those " which result from the very conditions of
our existence."

The states of health and disease, therefore, are not dia-
metrically different things, not fundamentally opposite the one
from the other. In all cases disease is primarily an affection of
vital power modifying vital action, and showing itself by a
modification of vital phenomena. But it is an affection, modi-
fication, and manifestation of the same phenomena, the same
actions, and the same powers which are natural to the body, and
which, when acting and manifesting their action naturally, con-
stitute the state or condition of health. The vital powers, and
the resulting actions and phenomena, may be very variously
affected and widely diversified in their manifestations and in
their acting ; but the state of disease implies no affection of any
new or additional power, no modifications even of actions or of
phenomena other than those which attach to the state of health.
And a clear conception of the true relation in which the two
states of health and disease stand towards each other, while it
will conduce to clearer apprehensions of what they both are, will
show how futile it is to seek to define them otherwise than in
very general and relative terms.

* Alison's " Outlines of Pathology and Practice of Medicine."

13

§3.

The simplest exemplification of the diseased states to
which the living body is liable, is to be found in the natural
history of cases of Sudden Death, and of Violent Injuries, Poi-
soning, Drowning, and such-like. And indeed the whole
science of disease, as well as the first principles of physiology
and of therapeutics, admit of illustration by a reference to these
" simplest cases in pathology.'^

The cases in question, occurring in persons previously in
perfect health, can, indeed, scarcely be said to be cases of dis-
ease. At least if they are to be so regarded, they are cases of the
least complex kinds and forms of it. The changes intervening
between the application of the external cause and the fatal event,
or the consummation of the effect which rapidly follows, must
necessarily he few in number and simple in their character. The
symptoms, too, accompanying the internal changes are equally
few and simple, and for the most part characteristic. And the
relation subsisting between the external causes and the effects
which they produce on the vital organs, has nothing occult in
it, but is direct and palpable and open to the observation of
every one.

It is widely different with most diseases. Arising often from
unseen or inappreciable causes, and often terminating fatally in
modes that are complex and obscure, they extend over a longer
period of time, consist of a longer series and a greater variety
of internal changes, involving many of the vital actions, and
showing themselves by symptoms which vary with their progress,
and are modified by the circumstances of individual patients.
Amid such a multiplicity and diversity of changes, it is often
exceedingly difficult to discriminate between the essential and
the incidental, to trace the connexion between causes and their
effects, or to acquire clear notions of the real nature or the true
import of the phenomena that we witness.

This being the case, it is easy to understand that we should
often be unable, from the observation of diseases themselves, to

14

form a correct judgment of the nature of many diseases which
come before us in actual practice. But this difficulty may often
be greatly obviated or entirely removed by a careful comparison
of diseases, with the known effects of violent or rapidly fatal
injuries, such as sudden concussion or compression of the brain,
poisoning, profuse hjemorrhage, starvation, drowning, lightning-
strokes, the sudden application of intense heat or of intense cold,
&c., — these simple cases furnishing us with facts and principles,
or with analogies and illustrations that admit of an easy and
direct application to morbid processes and morbid phenomena.

It is greatly to be regretted that this most interesting and
instructive department of medical science, which may be said to
occupy a middle ground between physiology and pathology,
shoxild have hitherto received but comparatively little attention
from systematic writers and teachers. Dr. Ahson and Dr.
Latham, however, have fully appreciated its importance; and
the former of these writers has treated it systematically and in
detail in his " Outlines of Pathology and Practice of Medicine,"
making it, in fact, the introduction to that admirable work.

CHAPTER III.

Of the Natural History of Diseases— Their Modes of Favourable and of
Fatal Termination, as occurring spontaneously — And of the Curative
Powers and Provisions of Nature.

§1.

OF THE GENERAL NATURE OF DISEASES.

Distinction to be drawn between the pathological and the
nosological meanings of the term Disease — a distinction corre-
sponding to that in physiology between vital actions or processes
and vital phenomena. Pathologically considered, disease is an
abnormal aflFection of some one or more of the vital powers,
modifying more or fewer of the resulting vital actions. And the
attendant modifications of vital phenomena are regarded and
spoken of as the symptoms of that affection. Nosologically con-
sidered, disease is a combination and succession of abnormally
modified vital phenomena, the result of abnormally modified
vital action, — the latter, in this point of view, being regarded
and often technically called, particularly by the older writers, the
proximate cause of the disease.

Pathological states, or morbid processes, and nosological dis-
eases, not always coincident ; the same diseased state being
often attended by very various symptoms ; and, conversely, the
same combination of symptoms being often attendant on widely
different diseased states.

As medical science has advanced, this discrepancy has been
lessened, and there is reason to hope will be still farther

16

diminished as the science advances ; but we see enough to make
it probable that it never will or can be altogether removed.

(1.) Of Symptoms; and of Diseases considei'ed Nosologically .

Symptoms are either uneasy or altered natural sensations,
or alterations in the sensible qualities of some part or parts of
the living body, or appreciable modifications in the actions of
its different parts. This definition w^ide enough to include also
what some writers designate the physical signs of disease.

i. Of certain combinations and successions of symptoms, as
applied both to the purposes of nosology and to the diagnosis
and the prognosis of individual cases of disease.

ii. Of certain combinations and successions of symptoms
distinct from those on which any nosological arrangements are
founded; distinct also from those on which the differential
diagnosis of diseases is founded; but of the highest practical
importance in many cases in which the real nature or the precise
seat of the disease cannot be determined, or is doubtful — e. g.
such combinations as we express by the terms typhoid tendency,
inflammatory tendency, tendency to syncope or asthenia, tendency
to coma or to asphyxia, hemorrhagic tendency, cachectic tendency,
scorbutic tendency, and such-like.* In such cases, a clear per-
ception of the import of these various combinations, common to
many and very different diseases, will often guide the prac-
titioner aright in his treatment of them, and in his judgment of
their probable issue.

(3.) Of Diseased Actions or Morbid Processes; and of Dis-
eases considered Pathologically.

i. Distinction between pathology and morbid anatomy.
Pathology the science of diseased actions, not of diseased struc-
tures: all organic lesions the result of pre-existing diseased
actions ; many diseases unattended, throughout, with any appre-
ciable change of structure, and proving fatal without leaving
any morbid appearances behind them in the dead body.

ii. Of the ultimate or proximate elements of morbid actions
or processes. These elements referable to changes in the vital

* Alison's " Outlines of Pathology and Practice of Medicine."

17

powers, induced by the exciting causes of diseases, — changes
in the chemical and in the plastic affinities, and in the vital
properties of contractility and of nervous agency. Difficulty
in satisfactorily prosecuting this department of pathology : great
progress made in it, however, of late years, and still greater
yet to be expected.

iii. Most diseases involve, or consist in combinations of
different kinds and degrees of these proximate elements of
morbid action ; and as well in a scientific as in a practical point
of view, it is these combinations that we chiefly regard. Dis-
tinctions of diseases, founded on this large and more accessible
view of them, into acute and chronic, or febrile and non-febrile ;
and of the acute or febrile into the inflammations, strictly so
called, and the idiopathic febrile diseases ; and, again, of the
chronic or non-febrile into the functional and the organic, —
each of these last admitting of several subdivisions, and in-
cluding the haemorrhages, the dropsies, nervous disorders, &c.

OF THE NATURAL COURSE, PROGRESS, AND TERMINATIONS

OF DISEASES.

We treat here more particularly of the natural tendencies of
diseases, whether favourable or unfavourable, and of the modes
of dying and healing, as occurring spontaneously. And, as
directly connected with this part of the natural history of
diseases, we treat here also of the powers and conditions of
vitahty, as illustrative as well of the natural cure as of the
naturally fatal event of diseases.

(1.) Of the favourable tendencies and modes of favourable
termination of diseases, together with the provisions of nature for
their spontaneous cure.

i. Of the temporanj duration of all diseased action as a
general fact, and of the degree or intensity of most kinds of
diseased action being, while they last, within the limits of
safety or of the powers of endurance of the living body, best

B

18

exemplified in the idiopathic febrile diseases, but exhibited also
in the inflammations, and in many chronic diseases of a func-
tional character.

It was formerly remarked, that while the living body is so
constituted as to be liable to act abnormally, it is yet so con-
stituted as to tend always to act in the manner designed by
nature. And to this it may be added, as furnishing the ex-
planation of the temporary character of diseased action, that the
tendency in question continues to be exerted even when the
body is acting abnormally.

ii. Of the modes and processes whereby the weakening effects
or the positive lesions of diseases are repaired or overcome.

a. Spontaneous recovery of strength and vigour, after the
subsidence of the disease, through the restoration of the natural
actions of digestion and nutrition, exercise in the open air,
gentle mental excitement, &c.

b. Removal of morbid effusions by the natural action of
absorption, — of lymph by conversion into pus, and the discharge
of this, — and of the adhesive, ulcerative, and even the sloughing
processes, and of the process of granulation, as curative provi-
sions of nature.

c. Of the provisions for the spontaneous subsidence of
hsemorrhagic effusions, and for the healing of the ruptured
vessels, as well as for the removal of effused blood from the
parenchyma of organs, or from the shut cavities of the body.

d. Of muscular hypertrophy, as a provision of nature for
obviating the effects of certain permanent lesions, particularly
in the case of the heart; and, in the case of double organs, e.g.
the kidneys, of the preternatural development of the sound organ
and increased activity in its function to compensate for the lesion
of the other.

e. Of the more important of the regimens, e.g. the anti-
phlogistic or the tonic, or the combination of these two, through
which the curative operations of nature are greatly promoted,
being instinctively adopted by invalids, and therefore, as thus
imposed on them, rightly to be included among the provisions
of nature for the spontaneous cure of diseases, &c.

19

(2.) Of the unfavourable tendencies and modes of fatal ter-
mination of diseases.

i. Of death and the tendency thereto in the way of Coma.

ii. Of death and the tendency thereto in the way of As-
phyxia.

iii. Of death and the tendency thereto in the way of—

(When occurring suddenly) Syncope.
(When occurring gradually) Asthenia.

iv. Of combinations in the modes of death, and in the ten-
dencies thereto, now enumerated.

The physiology of these several modes of dying ; the circum-
stances under which they occur in the course of various diseases ;
means by which in certain cases they may be counteracted ; and
of obviating the tendency to death, and watching for the earliest
indications of this tendency with that view, — while mainly rely-
ing on nature for the cure of the disease, as the most important
practical object to be attended to in the treatment of many dis-
eases : e.g. An hospital surgeon, making his round one morning,
came to the bedside of a patient admitted the previous day,
whom he found to be labouring under acute laryngitis. Before
quitting him he performed the operation of laryngotomy, re-
marking to the pupils that, although the case scarcely seemed
to call for it, and might never really do so, he had thought it his
duty to perform the operation, — because such an aggravation of
the disease might at any time supervene as would prove fatal
befpre assistance could be procured. He had obviated that con-
tingency, and having secured the safety of his patient, should
now have no anxiety about the case, and would probably re-
quire to do nothing more for it, as the laryngitis would no
doubt quickly subside of its own accord.

B 2

CHAPTER IV.

Of the Preservation of Health and the Prevention of Disease —
Or, of Hygiene and Prophylaxis.

These two branches coincident in their practical object : they
differ only in their regarding that object from different points of
view. The one embraces an inquiry into the remote or external
causes of diseases^ with a view to the avoidance of those causes
by individuals and communities ; the other, an inquiry into the
positive conditions of life and health, with a view to the observ-
ance of those conditions by individuals and communities.

The subject of Hygiene has very generally been considered
as forming an integral part of the Materia Medica, while that of
Prophylaxis has been regarded as properly belonging to the
department of Pathology and Practice of Medicine. But the
same reason which excludes the latter from the Materia Medica
is sufficient to exclude the former also, and to transfer it to the
department of Physiology.

In the outline here given of the subjects of Life, Health, and
Disease, both branches will be treated of, and in the same
general way.

§1-

OF THE REMOTE OR EXTERNAL CAUSES OF DISEASE.

There is a well-known and just distinction of these into the
predisposing and the exciting.

(1.) Of the predisposition to disease, as a state or condition of
the living body itself, often innate and congenital, and trans-

21

mitted hereditarily, at other times gradually induced through
the agency of certain causes external to the body, and which
causes, in consequence of their action being thus limited, are
designated predisposing. Enumeration and consideration of the
more important of these causes.

(2.) Of the division of the exciting causes, or those to which
the production of diseases is more immediately referable, into
those which may be said to be constanthj and everywhere in
operation, and into those which are of local and temporary
operation only, or into the common and the specific. Alternations
of temperature (cold) an example of the former class; malaria,
and the poison of small-pox, examples of the latter. Distinc-
tions among diseases, arising out of these differences in their
exciting causes, into contagious and non-contagious, epidemic,
endemic, &c. Enumeration and consideration of the more im-
portant exciting causes, both common and specific.

Importance of attention to the fact that, very frequently, the
combined or concurrent agency of causes belonging to every one
of the classes mentioned — predisposing, common, and specific —
is concerned in the production of disease, and in many cases
seems to be nearly essential, in order to its excitation.

Of the importance, in a national point of view, of this whole
department of inquiry.

§2.

OF THE POSITIVE CONDITIONS OF LIFE AND HEALTH.

Of the conditions of life and health, considered as " organic
laws," to the infringement of which penalties are annexed.
These penalties being exacted indifferently from all, or without
favour or distinction, and uniformly, or without remission.

Enumeration and consideration of the more important of
these conditions — regard being had to both parts of man's
constitution.

1. Of food and raiment.

2. Of heat and light.

22

3. Of air and exercise.

4. Of rest and sleep.

5. Of washing and cleanliness.

6. Of work and recreation.

7. Of house and shelter.

8. Of sobriety and temperance.

PART IL

MATERIA MEDICA AND THERAPEUTICS, SYSTEMATICALLY

CONSIDERED.

CHAPTER I.

or THE ACTION 01" REMEDIES IN GENERAL.

What we understand by the term remedy in relation to disease,
and as distinguished from the curative powers inherent in the
living body itself. Not alone the substances comprised in the
pharmacopceia, and called medicines, but all means external to
the body, and all modes of acting upon it artificially, of what-
ever kind and in whatever way, by the use and application of
which the diseased actions of the living body may be beneficially
controlled and thereby removed or relieved.

Of the evidence we have of the efficacy of remedies in the
cure and the alleviation of diseases; of the sources of fallacy in
our estimate of their efficacy ; and, generally, of the kind and
degree of efficacy which we are warranted in ascribing to them.

Of \)a& physiological action of remedies, or their action on the
healthy body ; of the indications thence arising for their appli-
cation in disease ; and of the cautions requisite in the application
of them from the danger or inconvenience known to attach to
their action on the system.*

The mode of action of many remedies obscure ; that of some
altogether unknown, their efficacy being known to us only from
experience, and not referable to any general principle deducible
from the laws of the animal economy. These last designated
* Alison's « Heads of Lectures ou Therapeutics."

24

specifics ; the power of quinine over the intermittent fever an
example of this class of remedies.

Of the classification of remedies. Difficulties attaching to it
from differences in the action of remedies under different cir-
cumstances, and from other causes. Every classification more
or less arbitrary and imperfect. That here followed based on
the parts and actions of the living body, which the remedies to
be considered appear chiefly or primarily to affect, and are used
mostly with the intention of affecting.

CHAPTER II.

Of the Eemedies whicli act primarily or cMefly — and are used mostly
with the intention of affecting and influencing — the more strictly
Vital Processes and the Vital Organs.

General view of the states or conditions of the body, and of the
vital organs and their functions in particular, which demand or
indicate the use of remedies belonging to this division.

I. Of Stimiilants.

1. Of' stimulants in general.

2. Of particular stimulants.

II. Of Sedatives.

1. Of sedatives in general.

2. Of particular sedatives.

Of the Antiphlogistic regimen.
Of Bloodletting, general and local.

III. OfDerivants.

1. Of derivants in general.

2. Of particular derivants.

IV. Of Purgatives.

1. Of purgatives in general.

2. Of particular purgatives.

V. Of Emetics.

1 . Of emetics in general.

2. Of particular emetics.

VI. Of Anthelmintics.

1. Of anthelmintics in general.

2. Of particular anthelmintics.

I
I

26

VII. Of Antacids and Carminatives.

1. Of antacids and carminatives in general.

2. Of particular antacids and carminatives.

VIII. Of Tonics.

1 . Of tonics in general.

2. Of particular tonics.

Of the Tonic regimen.

Of the combination of the tonic and the antiphlogistic
regimens proper in many diseases, and in dif-
ferent stages or circumstances of the same
disease.

IX. Of Alteratives, Deobstruents, and Sorbefacients.

1. Of the general action of this class of remedies.

2. Of particular alteratives, deobstruents, and sorbefacients.

X. Of Diuretics.

1. Of diuretics in general.

2. Of particular diuretics.

XI. Of Sudorifics.

1. Of sudorifics in general.

2. Of particular sudorifics.

XII. Of Emmenagogues.

1. Of emmenagogues in general.

2. Of particular emmenagogues.

XIII. Of Astringents.

1. Of astringents in general.

2. Of particular astringents.

XIV. Of Expectorants.

1. Of expectorants in general.
2 Of particular expectorants.

XV. Of Errhines and Sialogogues.

1. Of errhines and sialogogues in general.

2. OF particular errhines and sialogogues,

27

XVI. Of Caustics and Epispastics.

1. Of caustics and epispastics in general.

2. Of particular caustics and epispastics.

XVII. Of Emollients.

1 . Of emollients in general.

2. Of particular emollients.

XVIII. Of Refrigerants.

1. Of refrigerants in general.

2. Of particular refrigerants.

General review of the action and application of remedies be-
longing to this division : — Of the ulterior as well as of the direct
effects of their action; e.g. of the sorbefacient and diuretic, as
well of the antiphlogistic action of blood-letting and of purga-
tives ; of the tonic action of astringents, purgatives, and emmena-
gogues, &c.

/

CHAPTER III.

Of the Remedies which act primarily or chiefly — and are used mostly
with the intention of affecting and influencing — the Mind and the
Organs of Animal Life.

General view of the states or conditions of the system, and of
the mind and the nervous and muscular systems in particular,
which demand or indicate the use of remedies belonging to this
division.

I. Of Narcotics and Anodynes.

1. Of narcotics and anodynes in general.

2. Of particular narcotics and anodynes.

II. Of Antispasmodics.

1. Of antispasmodics in general.

2. Of particular antispasmodics.

III. Of the action of Tonics and of Stimulants on the Nervous

System.

IV. Of the action of Sedatives on the Nervous System.

V. Of the Specific action of certain Remedies on the Nervous

and Muscular Systems.

VI. Of the Remedial action of Mental Causes. Of the Regimen

Mentis.

PART III.

MATERIA MEDICA AND THERAPEUTICS, PRACTICALLY
CONSIDERED.

CHAPTER I.

Of Nature and Art in the Cure of the several Kinds, Modes, or Forms
of Diseased Action ; excluding, however, all consideration of In-
dividual Diseases otherwise than as Illustrative of the Objects of
Practice, and of the Resources of Nature and Ai't in the Treatment

of each kind of Diseased Action brought under Review.

******

CHAPTER II.

Of Violent Injuries — Sudden Seizures, including Poisoning, Haemor-
rhage, &c. — The Objects of Practice in regard to them, and the
Resources of Nature and Art in the Cure of them.

CHAPTER III.

Of Inflammatory Diseases — Their Favourable and Unfavourable Ten-
dencies, and their Modes of-Favourable and of Fatal Termination —
Objects of Practice in regard to them ; and the Resources of Nature
and Art in the Cure of them.

30

CHAPTER IV.

Of the Idiopathic Febrile Diseases— Their Favourable and Unfavourable
Tendencies, and tlieir Modes of Favourable and Unfavourable Ter-
mination—Objects of Practice in regard to them; and the Re-
sources of Nature and Art in the Cure of them.
* * * # *

CHAPTER V.

Of the Chronic o» Non-febrile Diseases — General View of the Modes of
Diseased Action, and of the Kinds of Morbid Stnicture observed in
Diseases of this class — Of the Objects of Practice in regard to
them ; and of the Eesources of Nature and Art in the Cure or
the Alleviation of them.

I. Of Chronic Diseases of the Heart and Bloodvessels ; and of

the Remedies for them.

II. Of Chronic Diseases of the Respiratory Organs ; and of the

Remedies for them.

III. Of Chronic Diseases of the Digestive Organs ; and of the

Remedies for them.

IV. Of Chronic Diseases of the Urinary and Genital Organs ;

and of the Remedies for them.

V. Of Chronic Diseases of the Nervous System; and of the

Remedies for them.

CHAPTER VI.
Of the Art of Prescribing.